Make Every Contact Count – Tackling Obesity
10th January 2019
Obesity is the second biggest preventable cause of cancer in the UK, with Cancer Research UK reporting that more than 1 in 20 cancer cases are caused by excess weight. The risk increases with the more weight a person gains and the longer they are overweight for. Yet small changes that are maintained long-term can make a significant difference. Making every contact count (MECC) is an approach to behaviour change that utilises daily interactions to encourage others to make a behaviour change which would have a positive effect on health. This is an important initiative run by Health Education England which can be implemented by GPs to encourage patients to lose weight.
Every contact you have with a patient as a GP ought to be used to help the individual maintain or improve their mental and physical health, and well-being. More specifically, the four main lifestyle factors which ought to be targeted are: diet, exercise, alcohol and tobacco. In 2016, 26% of adults in the UK were classified as obese. Moreover, there were 617,000 admissions in NHS hospitals where obesity was reported as a factor.
Continuing the theme of New Year’s resolutions, as a GP you have the potential to play a key role in your patients’ potential weight loss journey this New Year. A vital component of motivating your patients to want to lose weight is openly discussing the individual’s weight and the impact on their health. However, many people visiting their GP with problems associated with excess weight hope they can be helped with medications. It is common for people to become defensive when their GP raises this topic. Although the obvious approach may appear to be to attempt to persuade your patients to lose weight to solve their health problem, this can often increase resistance and lessen the likelihood of action. It is important to have an understanding approach which enables trust to be built and encourage the individual to consider their weight without feeling judged. Perhaps begin by asking your patient about their own attitude towards their weight by saying “Has your weight changed over the past year and how is this affecting you?”
NICE have endorsed communication techniques drawn from motivational interviewing. Applying these concepts as a GP means encouraging your patient to talk about themselves and showing that you are listening. Avoid closed questions which prevent individuals from thinking for themselves. Rather, use open questions to find out what their weight means to them, any associated issues they have experienced and any potential health risks they foresee. This style of communication supports patients to think about their weight and open up to you. You can approach any resistance to change by highlighting your patient’s personal choice (e.g. “What do you think could happen if you choose to do nothing?”). Finally, summarising everything that has been said allows patients to hear themselves from a new and different perspective, which often motivates people to consider making a change.
Always remember to approach this topic with sensitivity. It was found that overweight people have reported being mocked by passers-by, insulted by shop assistants, ignored by bar staff and ridiculed by the opposite sex. A survey by Slimming World of 2,573 people found this weight discrimination did not motivate people to lose weight but led people to feel ashamed (47%), depressed (41%) and useless (30%). Even worse, 65% reported turning to food for comfort.
Of course, it is hugely valuable to signpost your patients to available support for loosing weight, such as Slimming World and WW (Weight Watchers). However, as a GP, you also have the vital role of motivating your patients to want to lose weight and access available support. Finding the motivation is often much harder than finding the resources. And remember, make every contact count!